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STATE RESOURCES

South Dakota Required Postings and Forms

Please post the following Anti-Fraud Notice, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunchroom or near the time clock. Please also post at least one of the three safety postings listed below in a conspicuous location. These are state-recommended safety postings with no required format. If you have multiple office locations be sure to post the notices at each location.

EMPLOYERS has chosen to work with Stubbe Dakota Case Management as our Certified Case Management Plan. Click here for more information.

The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:

First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. Fatalities must be reported within 24 hours. Please use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.

Wage Statement. This form enables us to calculate the correct compensation that may be owed to your injured employee. Please complete the form and submit it to EMPLOYERS within five days after your knowledge of any accident that has caused your employee to be disabled for more than three scheduled work days.

First Fill Form. This form provides your employees with basic information about our Pharmacy Benefit Program, including such things as the phone number to call to locate a First Fill participating pharmacy. When your employee becomes injured, please print and complete this form and provide it to your injured employee. Your employee will need to provide this completed form along with the drug prescription for his/her work-related injury or illness to the pharmacist. Using this form will help enable quick authorization for your employee’s initial medication and ensure that the initial prescription is provided at no cost to the injured employee.

Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon as possible after the accident. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.

Find a Pharmacy

EMPLOYERS Pharmacy Benefit Management program offers access to Point of Sale and Mail Order Pharmaceuticals. We utilize prospective, concurrent and retrospective clinical protocols, along with a drug formulary designed specifically for workers’ compensation injuries and diseases. To see your pharmacy information and providers, please select from the list below, the state in which your injury occurred.

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EMPLOYERS® and America's small business insurance specialist® are registered trademarks of Employers Insurance Company of Nevada. Insurance is offered through Employers Compensation Insurance Company, Employers Insurance Company of Nevada, Employers Preferred Insurance Company, and Employers Assurance Company. EIG Services, Inc. (in California, dba EIG Insurance Services) is an affiliated agency and adjuster. Not all insurers do business in all jurisdictions. A forward-looking statements disclaimer is an integral part of this website. *Quote availability is subject to applicable underwriting guidelines. Submitting the quote request form will not provide you with an instant quote, nor is it an application for workers' compensation insurance. By providing the information, you agree that we can share the information provided with one of our appointed insurance agents who will contact you personally within the next few business days.